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Viet Nam - Quang Ngai: Undiagnosed illness, 26 fatalities since April 2011

Re: Undiagnosed illness - Viet Nam: Quang Ngai, ProMED RFI - environmental contamination suspected

Re: Undiagnosed illness - Viet Nam: Quang Ngai, ProMED RFI - environmental contamination suspected

The symptoms and high copper levels in blood samples do suggest some kind of heavy metal toxicity. Copper is often found with other more toxic metals (such as lead, cadmium, arsenic, nickel, cobalt, etc.) that are present at much lower concentratons. Some toxic metals accumulate in fat tissue, organs, or other parts of the body and are not found at high concentrations in blood. So, although copper has been detected, it might not be the primary causative agent.

On the other hand, copper is also a common component of many pesticides and herbicides, so earlier suggestion of toxic levels of pesticides is also a distinct possibility.

Toxicity from metals or pesticides causing the symptoms listed would suggest an acute exposure that would likely have occurred only since shortly before the first symptoms appeared. If the people showing symptoms live in communes, then it would help to note any changes over the past year that could have created an exposure pathway. The first would be the source of drinking water. Do they have new sources of water or a recently installed water system? Poorly manufactured copper piping can leach high concentrations of metals into the water. Next would be a food exposure - any new food sources where chemicals would have been used? There could be a direct skin exposure from soil, building materials, etc. Given the lesions on the hands and feet, a direct contact exposure seems very possible. Inhalation seems less likely based on the symptoms, but it should also be considered. Any recent burning of building materials or trash? Some poor communities have been known to melt recycleable metals from electronics in their cooking pots. Something like this would create multiple exposure pathways, including inhalation. It could also be a combination of two or more pathways from different causes.
 
Re: Undiagnosed illness - Viet Nam: Quang Ngai, ProMED RFI - environmental contamination suspected

Re: Undiagnosed illness - Viet Nam: Quang Ngai, ProMED RFI - environmental contamination suspected

12 patients cured of unknown skin disease
The Quy Hoa National Leprosy Dermatology Hospital in the central province of Binh Dinh has cured 12 patients suffering from an undiagnosed skin disease that causes ulcers on hands, feet, mouth, back and abdomen, said Dr. Nguyen Thanh Tan, director of the hospital on Sunday.

Ten patients were discharged from the hospital and two of them will return home in a few days.

Within the last four months, the hospital had received 12 patients, who were transferred from hospitals in the central province of Quang Ngai.

...

The Department of Health in Quang Ngai said 98 people, including 25 children, have suffered from the skin disease, with some succumbing to it.

Among the 12 discharged patients, 20 year-old Pham Thi An was taken to the hospital in severe condition.

Her organs had all failed and she suffered a heart attack. Her husband and mother-in-law were cured, but her 4-year-old son died of the disease after 10 days of treatment in the General Hospital in Da Nang City.

http://www.saigon-gpdaily.com.vn/Health/2012/1/99313/
 
Re: Undiagnosed illness - Viet Nam: Quang Ngai, ProMED RFI - environmental contamination suspected

Re: Undiagnosed illness - Viet Nam: Quang Ngai, ProMED RFI - environmental contamination suspected

Could this be a form of leprosy? This is the first mention of that disease in conjunction with this outbreak.

http://english.vietnamnet.vn/en/soc...vince-entreats-help-from-health-ministry.html

Last update 12/01/2012 02:00:00 PM (GMT+7)


Central province entreats help from Health Ministry
VietNamNet Bridge ? The authorities of Quang Ngai province on January 11 asked the Ministry of Health?s urgent intervention to control a strange skin disease which is quickly spreading in the province.

The province?s Chair Cao Khoa asked the Ministry to send another working group to the mountain district of Ba To, to research and define the reason that cause the strange disease, to suggest treatment methods in order to prevent the epidemic.



Despite many measures carried out by the local health department and big hospitals in Vietnam, the number of patients is on the rise in Ba Dien commune of Ba To district.



Last October, the Ministry of Health?s experts visited Ba Dien to survey and give examination to local peole but they did not find out the reason.



By January 11, Quang Ngai had 106 patients who committed this strange disease. Some 90 of them recovered while 10 are now cured at the Quang Ngai Policlynic and six at the Quy Hoa Leprosy ? Dermatology Hospital.



Since June 4, many residents in Ba Dien commune have committed with a skin disease disease, which cause ulcerates on their hands, feet, mouth, back and abdomen.



Tests reveal that these people have high liver enzyme, anemia, kidney failure but doctors could not find out the reason.



Dr. Nguyen Thanh Tan, director of the Quy Hoa Leprosy ? Dermatology Hospital, said that if the disease is detected earlier, patients can recover otherwise it will be very dangerous, especially for kids.
 
Re: Undiagnosed illness - Viet Nam: Quang Ngai, ProMED RFI - environmental contamination suspected

Re: Undiagnosed illness - Viet Nam: Quang Ngai, ProMED RFI - environmental contamination suspected

I don't know the size of the village, but if "most" of the children are being kept out of school, with only about 100 or so total cases over the past year, perhpas something in the school itself is linked to this outbreak? The report of 12 deaths is likely an error, given the other posts in this thread, and should likely read 12 cases in children.

This seems like an unusual step given what we know so far.

http://www.tuoitrenews.vn/cmlink/tuoitrenews/society/breakfast-tuoitrenews-january-7-1.57629

Most of students in Ba Dien Commune, Ba To District, Quang Ngai Province have not gone to school after 12 children, most of them under 10 years old, died allegedly from palmoplantar keratoderma, which is characterized by an even, thick, symmetric hyperkeratosis over the whole of the palm and sole, with unknown cause. The provincial Health Department is looking into the “strange” disease.
 
Re: Undiagnosed illness - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness - Viet Nam: Quang Ngai, ProMED RFI

http://www.promedmail.org/mbds

Published Date: 2012-02-15 03:49:11
Subject: PRO/MBDS> Undiagnosed illness - Viet Nam (03): Quang Ngai, update
Archive Number: 20120215.0379

UNDIAGNOSED ILLNESS - VIET NAM (03): QUANG NGAI, UPDATE
***********************************************

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Thu 9 Feb 2012Source: Thanh Nien News [edited]http://www.thanhniennews.com/index/pages/20120209-vietnam-looks-to-seek-help-from-intl-experts-to-identify-disease.aspx


Vietnamese health authorities are seeking help from international
experts in identifying an unusual skin condition -- suspected to be
caused by agrochemicals -- that has plagued the central province of
Quang Ngai since last year [2011], Tuoi Tre reported Thursday [9 Feb 2012].

Nguyen Trong Khoa, deputy chief of the Ministry of Health's Medical
Services Administration, told the newspaper that his agency also planned
to study the condition, which has affected more than 150 people and
killed 2 children as of last December [2011].

Patients have ulcers on their hands and feet that look like they were
caused by severe burns, stiffness in the limbs, and, in serious cases,
liver damage.

Local health officials have linked the condition with plant protection
chemicals.

Tuoi Tre said Deputy Minister of Health Nguyen Thi Xuyen recently
approved a regimen for diagnosing and treating the condition. It says
mild symptoms can be treated with ointments, anti-inflammation drugs,
and vitamins, together with a dietary regime and liver supplements.
Those with severe symptoms have to be admitted to hospital for treatment.

The regimen also advises people to wash their hands and feet after
coming back from fields and avoid coming in contact with plant
protection chemicals.

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[This newswire reports that more than 150 people were affected by a
strange disease with skin and liver symptoms; among those, 2 people
died. The reported number of affected cases in this newswire is larger
than the number of 98 cases reported by media earlier (see prior
PRO/MBDS posting Undiagnosed illness - Viet Nam (02): Quang Ngai, update
20120110.0073.). This report states that the exact pathological agent of
the disease has not been identified, though agrochemicals are suspected.

PRO/MBDS would appreciate further information from knowledgeable sources
regarding this undiagnosed illness in Quang Ngai province, Viet Nam.
 
Re: Undiagnosed illness - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness - Viet Nam: Quang Ngai, ProMED RFI

The fatality rate this year seems higher than last. This year, they seem to be reporting 7 fatalities oout of 63 (or 70?) cases, for a CFR of 11.1% (or 10%). Last year they reported 2 fatalities out of over 100 cases, for less than a 2% CFR. One has to wonder whether a change in surveillance is responsible (perhaps unrelated conditions were included last year?) or perhaps the increase in fatality rate is real (perhaps due to a higher concentration of a toxin?). A change in CFR might also suggest a multiple etiology outbreak, which would also explain the variation in reported symptoms.

Four fatalities in two weeks this April seems like an acceleration of the outbreak.

http://www.promedmail.org/

Published Date: 2012-04-14 10:07:13
Subject: PRO> Undiagnosed illness - Vietnam: RFI
Archive Number: 20120414.1100691

UNDIAGNOSED ILLNESS – VIETNAM : REQUEST FOR INFORMATION
*********************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: 11 Apr 2012
Source: Saigon GP Daily
http://www.saigon-gpdaily.com.vn/Health/2012/4/100698/

One more dead from strange skin disease in Quang Nai Province An unidentified skin disease spreading in the central province of Quang Ngai since last year has killed one more person last week, bringing the total number of fatalities in the first fortnight of April to four, said a medical official on 10 April 2012.

Dr. Dang Thi Phuong, director of Ba To District Medical Centre, confirmed that a 4-year-old from Lang Rieu village in Ba Dien Commune died of the unidentified disease at the Quy Hoa National Leprosy Dermatology Hospital on April 9.

This is the 4th patient to have died of the disease within the first fortnight of April. Since the beginning of the year, 7 people have died in the province from this unusual and as yet unidentified skin disease. Their deaths were caused by multiple organ failure, such as liver damage.

According to Dr. Phuong, since the beginning of this year, 63 people have suffered from conditions like stiffness in the limbs and ulcers on hands and feet, that resemble severe burns and flaking of skin. Three patients are still in critical condition.

Last year the province recorded more than 150 people with similar symptoms.

While Vietnamese health authorities have yet to identify the disease, the Ministry of Health has approved a regimen for diagnosing and treating the condition.

Under this protocol, mild symptoms can be treated with ointments, anti-inflammation drugs and vitamins, together with a dietary regime and liver supplements.

Those with severe symptoms, including liver damage, have to be admitted to hospital for treatment.

The regimen also advises people to wash their hands and feet after coming back from the fields, and avoiding direct contact with pesticides and other such chemicals.

A mission team from the Ministry of Health will arrive in Quang Ngai Province and Ba Dien Commune on 13 April 2012, to check on areas where most of the patients were reported, to study the cause and development of the disease.
--
Communicated by:
ProMED-mail Rappateur Mary Marshall



[There are only a few clinical signs and hints in this piece. Pesticides are hinted at, as is liver failure and several layers of severity of this malady. It also seems to affect all ages. So one has to wonder if it is brought in from the fields, carried by the water of is something else. There are not enough clinical signs to rule out or rule in anything specific.

While the article indicates it may be a contact type of situation, it does not tell us the immune status of any of the people involved and that may or may no be a factor in the malady.

We hope there will be more official information to share.

Vietnam may be found on the interactive healthmap at: http://healthmap.org/r/1jtz. - Mod.TG
]
 
Re: Undiagnosed illness - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness - Viet Nam: Quang Ngai, ProMED RFI

Some new symptoms and epidemiology as well.

http://www.saigon-gpdaily.com.vn/Health/2012/4/100732/

Friday, Apr 13, 2012, Posted at: 15:02(GMT+7)

Bizarre skin disease continues to spread
More people are reported suffering from stiffness of the limbs, respiratory problems and miscarriages, caused by a peculiar and unidentified skin ulceration that has plagued the central province of Quang Ngai since April, said medical authorities from the province.


Pham Thi An, 20, in Reu village, Ba Đien commune, Ba To District is recovering ( Photo: Thanh nien)
According to statistics of the Son Ha District Medical Centre on April 11, the numbers of people suffering from the bizarre skin disease have increased to 50, most of them being residents of Son Ba and Son Ky Communes.

Since March 8 to date, three inhabitants of Son Ky Commune have succumbed to the disease and 13 others are suffering from eye disease and respiratory problems.

Medical experts suspect the victims are suffering from poisoning from chemical herbicides, as they were affected soon after spraying the chemical in cassava fields.

The provincial health authorities have yet to determine the cause of deaths, but believe use of high contents of chemical herbicides have polluted the water sources in the commune.

Residents in these communes use an American brand herbicide named Kanup 480 SL, imported by the Viet Thang Company in the northern province of Bac Giang. The chemical was offered for sale on the company’s catalog on November 5, 2011.

Samples of water, soil from cassava fields and herbicide packages have been collected for testing. Preventive medicine centres in the province have warned people not to use the present water source but find an alternative source. Farmers must eat meals before spraying on fields and drink sugar water when experiencing symptoms and visit a medical centre immediately.

[snip]

-----------

This one is a week old:

http://www.thanhniennews.com/index/...kin-condition-kills-3-in-central-vietnam.aspx

Unidentified skin condition kills three more in central Vietnam
Last Updated: Thursday, April 05, 2012 05:00:00

An unidentified skin condition that has been seen in the central province of Quang Ngai since last year killed three residents in the past week, the Dan Tri newswire reported Thursday.

The new cases have brought to five the number of people in the province that died because of the unusual condition, which has been suspected of being caused by plant protection chemicals.

The latest victims were two girls aged 15 and 10, and a 21-year-old woman.

They died of multiple organ failure, including their livers, the report said.

According to Quang Ngai’s Department of Health, since the beginning of this year, 59 people have suffered the condition - ulcers on their hands and feet that look like they were caused by severe burns, and stiffness in the limbs

Last year the province recorded more than 150 people with the symptoms.

While Vietnamese health authorities have yet to identify the disease, the Ministry of Health has approved a regimen for diagnosing and treating the condition.

Under this protocol, mild symptoms can be treated with ointments, anti-inflammation drugs, and vitamins together with a dietary regime and liver supplements.

Those with severe symptoms, including liver damage have to be admitted to hospital for treatment.

The regimen also advises people to wash their hands and feet after coming back from the field and avoid coming in direct contact with plant protection chemicals.
 
Re: Undiagnosed illness, 7 fatalities - Viet Nam: Quang Ngai, ProMED RFI - herbicide poisoning suspected

Re: Undiagnosed illness, 7 fatalities - Viet Nam: Quang Ngai, ProMED RFI - herbicide poisoning suspected

http://english.vietnamnet.vn/en/society/21163/bizarre-skin-disease-continues-to-spread.html

Last update 15/04/2012 09:00:00 AM (GMT+7)


Bizarre skin disease continues to spread
More people are reported suffering from stiffness of the limbs, respiratory problems and miscarriages, caused by a peculiar and unidentified skin ulceration that has plagued the central province of Quang Ngai since April, said medical authorities from the province.





According to statistics of the Son Ha District Medical Centre on April 11, the numbers of people suffering from the bizarre skin disease have increased to 50, most of them being residents of Son Ba and Son Ky Communes.

Since March 8 to date, three inhabitants of Son Ky Commune have succumbed to the disease and 13 others are suffering from eye disease and respiratory problems.

Medical experts suspect the victims are suffering from poisoning from chemical herbicides, as they were affected soon after spraying the chemical in cassava fields.

The provincial health authorities have yet to determine the cause of deaths, but believe use of high contents of chemical herbicides have polluted the water sources in the commune.

Residents in these communes use an American brand herbicide named Kanup 480 SL, imported by the Viet Thang Company in the northern province of Bac Giang. The chemical was offered for sale on the company?s catalog on November 5, 2011.

Samples of water, soil from cassava fields and herbicide packages have been collected for testing. Preventive medicine centres in the province have warned people not to use the present water source but find an alternative source. Farmers must eat meals before spraying on fields and drink sugar water when experiencing symptoms and visit a medical centre immediately.
 
Re: Undiagnosed illness, 7 fatalities - Viet Nam: Quang Ngai, ProMED RFI - herbicide poisoning suspected

Re: Undiagnosed illness, 7 fatalities - Viet Nam: Quang Ngai, ProMED RFI - herbicide poisoning suspected

And the above article reveals the chemical:

http://www.sieuthinongnghiep.com/san-pham-header/chi-tiet/666/

[snip]

Active ingredient: Glyphosate IPA salt 480gr / l

--------------

http://en.wikipedia.org/wiki/Glyphosate

Glyphosate From Wikipedia, the free encyclopediaJump to: navigation, search Glyphosate

Glyphosate (N-(phosphonomethyl)glycine) is a broad-spectrum systemic herbicide used to kill weeds, especially annual broadleaf weeds and grasses known to compete with commercial crops grown around the Globe. Initially patented and sold by Monsanto Company in the 1970s under the tradename Roundup, its U.S. patent expired in 2000. Glyphosate is the most used herbicide in the USA.[3] Exact figures are hard to come by because the U.S. Department of Agriculture stopped updating its pesticide use database in 2008.[4] The EPA estimates that in the US during 2007, the agricultural market used 180 to 185 million pounds (82,000 to 84,000 tonnes) of glyphosate, the home and garden market used 5 to 8 million pounds (2,300 to 3,600 tonnes), and industry, commerce and government used 13 to 15 million pounds (5,900 to 6,800 tonnes), according to its Pesticide Industry Sales & Usage Report for 2006-2007 published in February, 2011.[5][6] While glyphosate has been associated with deformities in a host of laboratory animals, its impact on humans remains unclear.[6]
 
Re: Undiagnosed illness, 7 fatalities - Viet Nam: Quang Ngai, ProMED RFI - herbicide poisoning suspected

Re: Undiagnosed illness, 7 fatalities - Viet Nam: Quang Ngai, ProMED RFI - herbicide poisoning suspected

And a huge amount of info here, although I can't help notice there is no mention of skin problems. Could we have two different undiagnosed illnesses going on here? And the links above indicate this is a fairly common herbicide, marketed worldwide. If this is the cause of the illness, why is the illness only present in one area? Could there have been a bad batch of pesticide?

Also, the above post indicates that the pesticide comes in one liter bottles, containing 480 grams of active ingredient (powder?) to which the farmers fill with water and spray. If there is a problem in the local water supply, it will end up in the herbicide as well, so it may be difficult to differentiate between the two cases.

The situation remains very unclear.

http://chuminhkhoi.blogtiengviet.net/2012/04/13/cas_a_aong_thuar_c_trarl_car_gacy_ngar_a

Clarify the cause of many people in Quang Ngai blurred vision

(Vietnam Economic Times on 04/13/2012)
In recent days, some information in the wheat herbicide spraying (cassava) as two people died, many of blurred vision in Quang Ngai has made public opinion that the herbicide does not guarantee quality. Plant Protection Department of Quang Ngai province and the authorities have been findings.

- Chu Restore -

On some mass media recently reported on his Dinh Van Tuc (SN 1984) at Son Ky, Son Ha district, Quang Ngai province, after pumping 8 potion grass, home drinking dead, so absorbed herbicide. At the same time, she is his wife Tuc Dinh Thi land, grass while he sprayed Tuc has not been drunk and emergency medicine in time should have died. In recent years the whole area of ​​wheat in the Village Rieng village, Son States, people were spraying herbicides simultaneously, then new phenomenon of "strange" as above. According to CPC Son States, by 2010 the price of cassava increased, so farmers in the communal cassava area expansion. Currently, the commune has 500 ha of cassava. Previously farmers not using herbicides, only two years, farmers in the commune began to switch to spray weed competition for cassava cultivation. Many have blamed the herbicide households in Son States to use quality assurance, is the cause of death of two people, and 13 had blurred vision.
After the incident, Department of Plant Protection (Plant Protection), Quang Ngai province has worked with the CPC and the people at Son Ky Rieng villages to verify the facts. Report of the Plant Protection Department of Quang Ngai, said on the morning of 3/16/2012, Mr. Warranty Technical along with 10 others to collect plants for him to prepare the soil Warranty Technical field grown wheat. By noon, he felt a tired Warranty Technical and vomiting. Families invited to commune health and medication infusion, but a half hours of the morning, he Warranty Technical convulsions and died. So he and 10 others went Warranty Technical clearing land to grow wheat field, without the injection of pesticides and poisoning as one of the issues mentioned. Dinh Thi Le, his wife said Warranty Technical, around before the Lunar New Year, he is going Warranty Technical spraying herbicide for wheat Dinh Van temperature, while keeping the dispenser, the 480 SL KANUP Vietnamese company Thang in production of Bac Giang on 11/05/2011. Pesticide bottle stations Son Ha is currently stored. In the case of death of Dinh Thi Set (Warranty Technical mother his wife), on 7/3012 in the village have organized to celebrate the day 8/3, she placed participate and get drunk, then died the next day. Thus died she placed a week earlier, she placed no weeding the wheat while he sprayed Warranty Technical lead poisoning death as some newspapers reported.
Currently Rieng village has 13 people with blurred vision, of which only two suspects linked to the herbicide. With Mr. Dinh Van Marriage cases, a month ago, he was grazing cattle on the mountain spring water drink, when home, dizzy vomiting and blurred vision. Health has identified the medicine and water transfer but so far his eyes still see poorly. The particular cases specified, Nature (Rural Water Tiling, Son States), the CPC leadership said on 30/3, Fuel down her Son States Health Station emergency treatment due to severe eye redness, pain sensitivity. Before that, she and her husband Fuel spraying herbicide on the field for cassava, more than her husband Fuel injection. In the afternoon the same day, both have severe symptoms of vomiting, pale skin, blurred vision, Nature has her own symptoms more severe, very severe red eyes, sharp pain. The remaining cases of blindness not determined the cause. The authorities of Quang Ngai Province and Son Ha district authorities are continuing to test to find cause and cure for all people in the shortest time. To date only a few days of treatment, seven people were out and back home.
Vo Duy Loan, the Director of the Plant Protection Department of Quang Ngai confirmed two deaths not due to direct contact with the pump and wheat herbicide, blurred vision cases, the cause is unclear. But most recently, have added Dinh Van Lom in this village died on 04.05.2012, the family also suspected to be caused by herbicides. Chief of Quang Ngai Health Department, Dr. Le Huy stated opinion: "These types of herbicides are less toxic, the circulation is not likely to cause doc.Con shortest way to determine the cause the autopsy to the dead to take samples for testing. "However, the autopsy of the dead who are ethnic H're" bundle hand. " By their opinion, if removing parts of the body of the dead, when "the bottom, the ghost will be missing on demand, scared", and relatives of the dead not be determined.
Wang Changjiang, head of medicines management (PPD) said herbicide KANUP 480SL is the list of pesticides used in Vietnam, the herbicides registered for use on arable land. Now there are about 30 companies registered to trade in pesticides and NK drug business. With the content of active ingredients Glyphosate IPA Salt 480gr / l, the drugs are less likely to cause toxicity to the user. According to Director of Vietnam Thang Co., Ltd. (TP Bac Giang, Bac Giang province), the Company is providing KANUP 480SL herbicide for many farmers in communal areas are true Son States. KANUP 480SL herbicide only been this company register and bottling imported for consumption in the domestic market from 2011. Immediately after hearing media reports about the incident reflected and poisoning deaths, suspected by the company's herbicide caused officials of the company branch in Quang Ngai Son States directly to inquire into the facts. This company claims directors, herbicide is provided by the company with absolutely no quality problems! People in Son Ky improper spraying techniques, there is no protection and safety in use. Son Ha District has written recommendations for herbicide use, Division of Agriculture requires coordination with other communes and towns guidance to farmers to use drugs for production of biological proper technique , no pollution, to ensure the health of humans or animals.
At a recent press conference in Hanoi, Mr. Nguyen Xuan Hong, Director of Plant Protection, said: Among the pesticides, herbicides are the least toxic. All the commonly used herbicide in agriculture are now generally less toxic to humans and livestock with pesticides, fungicides (except for a few herbicide Paraquat). Recent years, has never recorded any cases of serious poisoning by herbicides used caused. Thus, the occurrence of death and poisoning due to drug use at Son Ky is not normal, should be thoroughly investigated to find out the cause. I was assigned to Quang Ngai Department inspector to clarify, verify the information. Initial results show that deaths from information herbicide is unwarranted. The PPD has taken the form of herbicides at the cassava growing areas in Son States to take tests, quality control, when the result, the Department will notify the public.
 
Re: Undiagnosed illness, 7 fatalities - Viet Nam: Quang Ngai, ProMED RFI - herbicide poisoning suspected

Re: Undiagnosed illness, 7 fatalities - Viet Nam: Quang Ngai, ProMED RFI - herbicide poisoning suspected

And this discards the herbicide theory, which was getting weaker over the past week due to its widespread use.

http://www.promedmail.org/mbds

Published Date: 2012-04-16 22:04:54
Subject: PRO/MBDS> Undiagnosed illness - Viet Nam (04): Quang Ngai, update, RFI
Archive Number: 20120416.0858

UNDIAGNOSED ILLNESS - VIET NAM (04): QUANG NGAI, UPDATE, REQUEST FOR
INFORMATION
***************************************************************************

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

[1]Date: Wed 11 Apr 2012Source: Sai Gon Giai Phong [edited]http://www.saigon-gpdaily.com.vn/Health/2012/4/100698/


One more dead from strange skin disease in Quang Ngai Province
-------------------------------------------------------------
An unidentified skin disease spreading in the central province of Quang
Ngai since last year [2011] has killed one more person last week,
bringing the total number of fatalities in the 1st fortnight of April
[2012] to 7, said a medical official on 10 Apr 2012.

Dr Dang Thi Phuong, director of Ba To District Medical Centre, confirmed
that 4-year-old [girl] from Lang Rieu village in Ba Dien Commune died of
the unidentified disease at the Quy Hoa National Leprosy Dermatology
Hospital on [9 Apr 2012].

[The girl] is the 4th patient to have died of the disease within the 1st
fortnight of April [2012]. Since the beginning of the year [2012], 7
people have died in the province from this unusual and as yet
unidentified skin disease. Their deaths were caused by multiple organ
failure, such as liver damage.

According to Dr Phuong, since the beginning of this year [2012], 63
people have suffered from conditions like stiffness in the limbs and
ulcers on hands and feet, that resemble severe burns and flaking of
skin. 3 patients are still in critical condition.

Last year [2011] the province recorded more than 150 people with similar
symptoms.

While Vietnamese health authorities have yet to identify the disease,
the Ministry of Health has approved a regimen for diagnosing and
treating the condition.

Under this protocol, mild symptoms can be treated with ointments,
anti-inflammation drugs, and vitamins, together with a dietary regime
and liver supplements.

Those with severe symptoms, including liver damage, have to be admitted
to hospital for treatment. The regimen also advises people to wash their
hands and feet after coming back from the fields, and avoiding direct
contact with pesticides and other such chemicals.

A mission team from the Ministry of Health will arrive in Quang Ngai
Province and Ba Dien Commune on [13 Apr 2012], to check on areas where
most of the patients were reported, to study the cause and development
of the disease.

[Byline: A Vinh]

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

******
[2]
Date: Fri 13 Apr 2012
Source: Sai Gon Giai Phong [edited]
http://www.saigon-gpdaily.com.vn/Health/2012/4/100732/


Bizarre skin disease continues to spread
----------------------------------------
More people are reported suffering from stiffness of the limbs,
respiratory problems, and miscarriages, caused by a peculiar and
unidentified skin ulceration that has plagued the central province of
Quang Ngai since April [2012], said medical authorities from the province.

According to statistics of the Son Ha District Medical Centre on [11 Apr
2012], the numbers of people suffering from the bizarre skin disease
have increased to 50, most of them being residents of Son Ba and Son Ky
Communes.

Since [8 Mar 2012] to date, 3 inhabitants of Son Ky Commune have
succumbed to the disease and 13 others are suffering from eye disease
and respiratory problems.

Medical experts suspect the victims are suffering from poisoning from
chemical herbicides, as they were affected soon after spraying the
chemical in cassava fields.

The provincial health authorities have yet to determine the cause of
deaths, but believe use of high contents of chemical herbicides have
polluted the water sources in the commune.

Residents in these communes use [Kanup 480 SL], a herbicide, imported by
the Viet Thang Company in the northern province of Bac Giang. The
chemical was offered for sale on the company's catalog on [5 Nov 2011].

Samples of water, soil from cassava fields, and herbicide packages have
been collected for testing. Preventive medicine centres in the province
have warned people not to use the present water source but find an
alternative source. Farmers must eat meals before spraying on fields,
drink sugar water when experiencing symptoms, and visit a medical centre
immediately.

[Byline: Ha Minh]

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[These newswires update the situation of the strange and undiagnosed
disease in Quang Ngai province. In the 1st 3 months of 2012, 63 people
were reported to have this disease and among those, 7 people died. In
2011, more than 150 people had this disease, and 2 people died. The
pathological agent has not yet been confirmed though a herbicide has
been pinpointed to be the cause of the disease. A specific herbicide
brand was identified. However, this herbicide has been imported since
November 2011 while the 1st report of the disease was in April 2011
.

PRO/MBDS would appreciate further information from knowledgeable sources
regarding this undiagnosed illness in Quang Ngai province, Viet Nam.

For a map of Viet Nam with provinces, see
http://upload.wikimedia.org/wikipedia/commons/f/f0/VietnameseProvincesMap.png.
For the interactive HealthMap/ProMED-mail map with direct links to other
outbreaks in Viet Nam and surrounding countries reported on ProMED-mail
and PRO/MBDS, see http://healthmap.org/r/2bxT. - Mod.QCN]
 
Re: Undiagnosed illness, 9 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 9 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

http://www.promedmail.org/

Published Date: 2012-04-17 22:41:15
Subject: PRO/EDR> Undiagnosed illness - Viet Nam (02): (QG) RFI
Archive Number: 20120417.1103583

UNDIAGNOSED ILLNESS - VIET NAM (02): (QUANG NGAI) REQUEST FOR INFORMATION
*************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Fri 13 Apr 2012
Source: Sai Gon Giai Phong [edited]
http://www.saigon-gpdaily.com.vn/Health/2012/4/100732/


More people are reported suffering from stiffness of the limbs, respiratory problems, and miscarriages, caused by a peculiar and unidentified skin ulceration that has plagued the central province of Quang Ngai since April [2012], said medical authorities from the province.

According to statistics of the Son Ha District Medical Centre on [11 Apr 2012], the numbers of people suffering from the bizarre skin disease have increased to 50, most of them being residents of Son Ba and Son Ky Communes.

Since 8 Mar 2012 to date, 3 inhabitants of Son Ky Commune have succumbed to the disease and 13 others are suffering from eye disease and respiratory problems.

Medical experts suspect the victims are suffering from poisoning from chemical herbicides, as they were affected soon after spraying the chemical in cassava fields.

The provincial health authorities have yet to determine the cause of deaths, but believe use of high contents of chemical herbicides have polluted the water sources in the commune.

Residents in these communes use [Kanup 480 SL], a herbicide, imported by the Viet Thang Company in the northern province of Bac Giang. The chemical was offered for sale in the company's catalog on [5 Nov 2011].

Samples of water, soil from cassava fields, and herbicide packages have been collected for testing. Preventive medicine centres in the province have warned people not to use the present water source but find an alternative source. Farmers must eat meals before spraying on fields, drink sugar water when experiencing symptoms, and visit a medical centre immediately.

[Byline: Ha Minh]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[While chemicals may be involved, it would be nice to have a comprehensive list of the situation. The clinical signs seem to be expanding. Also, are there any animals involved? If so what are the clinical signs? Certainly water may be the source of the exposure and if the water source is the same as for animals, then we may be able to get a more complete picture of what is happening here.

Maps of Viet Nam can be seen at http://upload.wikimedia.org/wikipedia/commons/f/f0/VietnameseProvincesMap.png and http://healthmap.org/r/1jtz. - Mod.TG]
 
Re: Undiagnosed illness, 9 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 9 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

http://www.saigon-gpdaily.com.vn/Health/2012/4/100790/

HEALTH Wednesday, Apr 18, 2012, Posted at: 11:24(GMT+7)

Another succumbs to bizarre skin disease in Quang Nai Province
One more person has succumbed to the bizarre and unidentified skin disease spreading in the central province of Quang Ngai, even as doctors struggle to find the cause of this strange ailment that has been plaguing people in the region.

On April 16, senior doctors at the general hospital in the central province of Binh Dinh confirmed the death of 46-year-old Nguyen Van Dat, a native of Reu village of Ba Dien Commune in Ba To District in Quang Ngai Province, from this rare skin disease.

Dat?s death has now brought the tally to eight since the beginning of the year. All the deaths caused by this unknown disease resulted in multiple organ failure, including severe liver damage
.

Previously, a mission team comprising of medical experts from the Ministry of Health had gone to Ba Dien Commune on April 13 to study the causes and development of the disease.

They worked in four groups; each group responsible for testing the environment, the skin disease, congestive disease and haematology study.

The group for congestive disease will study the daily activities and food habits of residents of Ba Dien Commune. Medical workers took hair and blood samples of over 3,000 residents; however, they have not yet come to any conclusions as to the cause of the disease.

Since the beginning of this year, 68 fresh cases have been reported in Ba Dien Commune, each suffering from stiffness of the limbs and ulcers on hands and feet, resembling severe burns and flaking of skin.

Last year the province recorded more than 150 people with similar symptoms; most of them natives of Ba Dien, Ba Xa, Ba Ngac and Ba Vinh Communes.

At present, 39 patients are being treated at the Quy Hoa National Leprosy Dermatology Hospital, four of whom are in critical condition.

The People?s Committee of Ba To District, in addition to calling for help from the Ministry of Health, has sent a request to the Viet-Russian Tropical Disease Centre and the Ministry of Defence, asking for assistance in finding the cause of the disease.
 
Re: Undiagnosed illness, 10 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 10 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

http://vietnamnews.vnagency.com.vn/social-issues/223677/fatal-disease-baffles-doctors.html

Updated April, 19 2012 10:12:10

Fatal disease baffles doctors

A boy with an unidentified skin disease with a doctor. The country's leading experts have yet to identify the disease, which has claimed eight lives since the beginning of the year.? File Photo

QUANG NGAI ? An unidentified dermatological disease has killed eight people since early this year, causing growing concerns among the residents of central Quang Ngai Province's Ba To District.
Doctors have been left baffled as to how to treat or even diagnose the disease.

Nguyen Trong Khoa, deputy head of the Health Ministry's Medical Services Administration, who led a team of medical experts that arrived to the province last Thursday, said that they were attempting to discover the root cause.

We have dispersed medical experts to survey the area. They have been divided into four areas of expertise: skin-related diseases, gastro-intestinal health, food hygiene and general safety, Khoa said.

This is the third time ministry officials have made health inspections. So far, however, they have failed to find any localised sources of infection.

The last victim, a 46 years old, from Ba Dien Commune, a region with the highest amount of sufferers of the disease, was pronounced dead on Monday.

According to local health agencies, 164 people have contracted the disease since last April, and 68 since the beginning of the year.

As many as 63 patients have been treated in the Quy Hoa National Leprosy Dermatology Hospital, located in central Binh Dinh Province.

The symptoms ranged from skin disorders to multi-organ failure, especially those involving the liver.

According to health experts, the fatality rate is extremely high among patients who show signs of multi-organ failure or digestive haemorrhage.

Symptoms include swelling and itching between the fingers and toes. After four to seven days, patients may experience thick or chapped skin, or even hair loss within two weeks.

Nguyen Thanh Tan, director of the hospital, said that the disease developed quickly and was difficult to treat
.

As far as short-term prevention, he said that it was very important that local people be provided with a fresh water supply.

In a related move, the local health department conducted a two-day examination of over 1,400 local people in Ba Dien Commune, which started last Friday, to diagnose and provide early treatment of the disease and to contain its spread. ? VNS
 
Re: Undiagnosed illness, 10 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 10 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

This might explain the apparent incrase in fatality rate; perhaps earlier fatalities were simply missed.

http://english.vietnamnet.vn/en/soc...-explore-bizarre-skin-disease-in-vietnam.html

Last update 19/04/2012 01:02:01 PM (GMT+7)


WHO experts to explore bizarre skin disease in Vietnam
VietNamNet Bridge ? The Ministry of Health will invite experts of the World Health Organization (WHO) to investigate the unidentified skin disease in Ba To district of Quang Ngai province in central Vietnam.

"We have decided to ask the Ministry of Health to ask assistance from the WHO and the US Disease Control Agency to research the bizarre skin disease. International experts are very interested in this disease and they are willing to help Vietnam,? says Mr. Nguyen Trong Khoa, vice chief of the Agency for Disease Examination and Treatment.

The Ministry of Health?s missions paid visits to Ba To district twice in last October and April 2012 to collect water and soil samples, as well as blood and hair of patients for testing, but until now they have not defined the cause of the strange skin disease.

According to the Quang Ngai Department of Health, 166 people have been infected with this disease, 8 of them died. However, Ba To district reports up to 19 dead patients.

At this moment, 39 patients are being treated at the Quy Hoa Leprosy Hospital in Binh Dinh province. Four of them are in critical conditions.

Experts from the Ministry of Health say that patients were poisoned because they suffered from skin wounds and viscera failure, particularly liver failure.

Local residents have got panic because of the strange disease.
 
Re: Undiagnosed illness, 10 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 10 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Vietnam asks WHO to help identify killer disease
The Associated Press, Hanoi, Vietnam | Fri, 04/20/2012 5:28 PM
Vietnam has asked international health experts to help investigate a mystery illness that has killed 19 people and sickened 171 others in an impoverished district in central Vietnam, an official said Friday.
The infection has mostly affected children and young people. It begins with a high fever, loss of appetite and a rash that covers the hands and feet. Patients who are not treated early can develop liver problems and eventually multi-organ failure, said Le Han Phong, chairman of the People's Committee in Ba To District in Quang Ngai province.
Nearly 100 people remain hospitalized, including 10 in critical condition. Patients with milder symptoms are being treated at home. The illness responds well to treatment if detected early, but 29 patients have been reinfected, Phong said.
...
http://www.thejakartapost.com/news/2012/04/20/vietnam-asks-who-help-identify-killer-disease.html
 
Re: Undiagnosed illness, 10 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 10 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Vietnam to seek WHO help to diagnose strange skin disease
At a meeting with the Ministry of Health in the central province of Quang Ngai on April 18, medical experts suggested that Vietnam should now turn to the World Health Organisation to identify the strange skin disease plaguing the people in this region.

A team of medical experts from the Ministry of Health had gone to Ba Dien Commune on April 13 to study the causes and development of the strange and unidentified skin disease.

They took samples of soil, hair, skin and various foods, to ascertain causes of the disease but all efforts proved futile.
...
According to the latest report from the health sector, the province has reported 171 infected cases and 19 fatalities. Since beginning of this year, 63 people are being treated at the Quy Hoa National Leprosy Dermatology Hospital, ten of whom are in critical condition.

Last year the province had recorded more than 150 people with similar symptoms.
http://www.saigon-gpdaily.com.vn/Health/2012/4/100820/
 
Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

While the outbreak seems to be spreading, and possibly accelerating, there is no evidence of person-to-person spread. Cases have been treated in Hanoi and Singapore without causing outbreaks there.

This could still be infectious, though, even if not contagious.

http://www.thanhniennews.com/index/...ition-death-toll-climbs-to-19-in-vietnam.aspx

Strange skin condition claims 19 lives in Vietnam
Last Updated: Thursday, April 19, 2012 04:50:00


A doctor examines a boy at Quang Ngai General Hospital for an unidentified skin condition which has killed 19 people in the central province over a year

Health authorities in the central province of Quang Ngai Wednesday said 19 local people have died from an unidentified skin condition over the last 12 months.

This is 11 more than the figure reported earlier by authorities in Ba To District, the disease’s epicenter.

Le Han Phong, chairman of Ba To People’s Committee, said the earlier figure did not take into account the victims who had died at home
.

“We know about the deaths, but because we were yet to identify their causes, we did not report them for fear of scaring local people,” said Dang Thi Phuong, director of Ba To’s health center.

It was found later that the unaccounted victims suffered the same symptoms as those who succumbed to the disease in hospitals, Phong said.

Since it broke out in the district in April last year, 171 locals have been infected by the disease which produces ulcers on hands and feet that look like severe burns and induces stiffness in the limbs, the Quang Ngai Department of Health reported at the meeting.

Most of the cases came from Ba Dien Commune, where eight people died, the department said, adding that other cases were recorded in four other communes, and one commune in Minh Long District.

At the moment, 49 people are receiving treatment at the Quy Hoa National Leprosy Dermatology Hospital in the adjacent province of Binh Dinh, and the Ba To health center, it said.

Ten of them are in critical condition. In fact, the skin condition, which is suspected to be caused by the use of plant protection chemicals, can lead to liver and lung failure in critical cases.

“The development of the disease at Ba Dien commune is really complicated and critical; the numbers of new cases and recurrence cases are increasing dramatically,” Phong said. “Local people’s lives are being threatened hour by hour.”

According to Phong, Ba To’s authorities have sent letters to Vietnam-Russia Tropical Centre, along with the Ministry of Defense’s health military and chemistry departments, asking them to step in to study the disease’s causes.

Meanwhile, Nguyen Xuan Men, vice director of Quang Ngai’s health department, said last October the Ministry of Health had assigned a delegation to Ba To to learn more about the disease, but nothing was found then.

Last week the ministry sent another delegation to take samples of water, food, and tissue from patients for further studies in cooperation with international experts, Men said.
 
Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Machine translation:

http://tintuchangngay4.wordpress.com/2012/04/20/bệnh-lạ-ở-quảng-ngai-dến-mức-bao-dộng-khẩn/

Unknown disease in Quang Ngai to the emergency alarm
20/04/2012

The signs of the disease "strange" on the palms rise like thick layer burns

Hanoi Vietnam

-

For many weeks, people chatted Ba To, Quang Ngai province are concerned about the appearance of a strange disease cause death. Vietnam sent a delegation of local health learn but have not found an answer, while Quang Ngai Health officials said the situation came to a serious level. Ha sent to Vietnam from Bangkok reports.


Unknown disease was spiraling out of control?
On the afternoon of March 18, the People's Committee of Quang Ngai province had convened an emergency meeting to find ways to cope with the strange disease appeared in Ba To district. Leaders of Quang Ngai Provincial Health Department evaluated the situation was serious and complex than in 2011. Mr. Pham Hong Phuong, director of Quang Ngai Provincial Health Department to let us know: Pham Hong Phuong: general and serious. Last year it took place in May this year but last year a little better that it happened quickly and out as quickly. This year is different is it a bit but then discharged into the central hospital in the end, in the fiercely that can not be controlled.

This year is different is it a bit but then discharged into the central hospital in the end, in the fiercely that can not be controlled.

Mr. Pham Hong Phuong
Strange disease began to appear from Ba Dien, of Ba To district in April 2011. Symptoms are palms feet, the toes of the patients with dry skin, thick horns. Some signs of fatigue, poor appetite, fever and numbness of the hands and feet. In more severe form, patients show signs of liver damage or may have complications such as pneumonia, septic shock, multiple organ failure.

The feet of a strange disease patients in Quang Ngai. Source vtc.vn
As reported by Quang Ngai Health Department, from April 19, 2011 to April 15, 2012 had 171 cases of this disease in five communes of the district, most concentrated in Ba Dien commune with 161 cases . From this year there were 7 deaths. 2011 is a case of death.

MOH has sent expert team of the health of Ba To district to check the actual situation from day 12 to April 14, but never has there been any concrete conclusions about the disease. There have been many theories put forward, such as hand, foot and mouth disease, or toxic chemicals, but are not sure. The medical experts also fear the disease could be related to one other serious diseases from Africa [?? -alert]. Local officials are worried not enough to cope with new diseases without the help from outside. Mr. Pham Hong Phuong said:

What disease ... it is not known, or like the color of the African fever, may be such that Quang Ngai but not in a position to do, including some in the central region is also difficult to have this problem . Currently, I also recommend if Vietnam did not find out they must resort to the World Health organization.

Mr. Pham Hong Phuong
Pham Hong Phuong: Hand, foot and mouth is not right, it's what the illness is unknown, or just like the color of the African fever, may be such that Quang Ngai but not in a position to do, including some in central region is also difficult to have this problem. Currently, I also recommend if Vietnam did not find out they must resort to the World Health organization.

According to Quang Ngai health, then it is time for this treatment of this disease, because not found the cause.

After the inspection trip situation in Ba To district of the Ministry of Health, local press quoted Nguyen Trong Khoa, deputy head of healthcare management said planned within a month, the group will complete the tests and the conclusion of this serious disease. If you can not find the cause, the group proposed the Ministry of Health invited the foreign experts with modern equipment and diagnostics to help Vietnam, a solution cure the disease.
 
Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Machine translation:

http://www.bacsigiadinh.com/1561/Benh--la--ma---khong-la-o-Quang-Ngai.aspx

DISEASE PREVENTION 20/04/2012 GMT + 7

-------------------------------------------------- ------------------------------

Patients 'strange' ... is not strange that in Quang Ngai
Bacsigiadinh.com - The mission of the Ministry of Health recently concluded survey of strange diseases Ba Dien Commune, Ba district, Quang Ngai, Dr. Tran Hau Khang, Director of Central Hospital of Dermatology, Group members said the first step is getting the inflammation of the feet and palms with liver dysfunction.


Delegation of the Ministry of Health for disease testing Ba Dien commune

(Ba To, Quang Ngai) Photo: Phu Duc.

The mission took samples such as skin, blood, soil, water, swabs, fruit brought to Hanoi in this test. Approximately 10% of patients with severe liver dysfunction and was taken to the Hospital District and provincial emergency and intensive treatment.

Specifically, these patients have hemorrhagic phenomena, reduced blood protit. Due to severe illness last week should have multi-organ failure patients, and death. With lesion of liver enzymes, they often have symptoms of malnutrition, physical weakness, inflammation of the hands and feet skin and liver failure leading to multiple organ failure death.

Dr. Tran Hau Khang said the Ministry of Health also offers treatment with the different levels. Accordingly, patients with hepatic dysfunction on the line to take on active treatment. TS.Khang said: "This is a dermatitis of the feet and hands have liver dysfunction. The people called strange disease because so far appear not where this disease. This disease is actually very easy to cure: just grease soccer, scales.

Typically, 5 patients given Central Hospital Dermatology previous treatment regimens also comply with peeling cream, promoted horn is completely gone. For patients with symptoms of high liver enzymes need to rest, drink extra nutrition and liver tonic. However, patients with high liver enzymes should be monitored and treated in the emergency department. " This treatment regimen is the contribution of all specialties based on epidemiological investigation and the initial tests.

There are no final conclusions about the cause of the disease. It takes 1 to 2 weeks more to the test results of samples from the leading specialist laboratories.

However, the initial assessment of the health professionals, based on epidemiological characteristics, yet we find evidence of spread from person to person. If there are only infected through contact of broken skin disease appears only in the hands and feet.

Mr. Nguyen Trong Khoa, Deputy Director of Clinical Management (MOH) said the purpose of the field trip is to continue the overall survey, research daily life of local people, find out causes of this dangerous disease because this disease is relatively complex.

Science when he said the survey results will eliminate gradually, find cause to cure thoroughly. Professionals will find the cause in three main directions: environmental factors; elements in food by micro-roots (as the disease can be transmitted).

If after all the test results did not detect the cause, the mission will report to the Health Ministry leaders suggest the World Health Organization and Centers for Disease Control and Prevention of Disease ( CDC) to support technical specialists to find the root cause.

From early 2012 until now, at Ba Dien commune has 68 new cases, 28 cases of recurrence and 8 cases were fatal. There are 63 patients with hand dermatitis, feet are treated in Hospital Room - Surgeons Dermatology Quy Hoa. - TPO

dermatitis la, la news of the disease in Quang Ngai, the disease is fatal, disease which is not la, bacsigiadinh, disease is fatal, the health ministry, was the cause, public health
 
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